Asthma in Children

Asthma is now seen as a quite common disease among children. It will always be painful when you come to know that your child suffers from asthma. But there is nothing to worry as the childhood asthma could be greatly controlled than adult asthma. During the course of child growth, the body undergoes many hormonal and physical changes which along with proper treatment help in controlling the disease.  Like adult asthma, the childhood asthma is caused by the inflammation of breathing tubes due to smooth muscle contraction. Mucous secretion to this inflamed breathing tube makes breathing even more difficult.

Symptoms of Childhood Asthma

Following are the symptoms of childhood asthma:

  • Wheezing
  • Coughing
  • Shortness of breath
  • Chest tightness
  • Difficulty in sleeping
  • Gets tired very soon during active play or exercise
  • Wheezing and coughing gets worse with respiratory infections like common cold and flu

Causes of Childhood Asthma

The symptoms of asthma are often induced by various “triggers”. Each individual gets the attack when exposed to specific set of triggers. The most common asthma triggering factors are:

  • Smoke, dust and other environmental pollutants
  • Pet dander
  • Pollen
  • Cold air and wet weather conditions
  • Infections like common cold
  • Fungus and its spores
  • Certain food items
  • Certain drugs
  • Exercise and sports activities
  • Emotional factors

The genetic constitution also plays an important role in case of childhood asthma. Since genes are inherited from parents, children of asthmatic parents have a greater chance of developing asthma. Other risk factors for developing asthma include obesity, low birth weight, hay fever (allergic rhinitis), eczema etc.

Childhood Asthma Treatments

The treatment is started only after proper diagnosis of the disease. The first step in the treatment is to keep the child away from all the possible triggers. Keep the child away from polluted environment, food items which may cause allergy should be avoided, avoid pets with fur and feathers, beddings and clothing should be clean and the play or exercise activities which triggers asthma attack should be avoided. 

 

The lung function should be monitored regularly using a peak flow meter. The peak flow meter will give a score value which indicates a child’s best effort value. If the peak flow meter gives a score value which is 20 percentages less than the child’s best efforts value it indicates the chance of asthma attack in the upcoming days.

Asthma often requires a lifelong treatment, thus a regular medical check up is always necessary. The treatment usually starts with a short term trial medicine for about one to three weeks. And depending on the effectiveness of the medicine, doctor may ask you to increase or decrease the dose and type of medicine. The medicines used are mainly of two types. They are:

Long Term Control Medications

Long term control medicines should be taken regularly without fail and it helps in reducing inflammation in child’s respiratory airways. Long term medication includes:

  • Inhaled corticosteroids - example: Flunisolide (Aerobid), Fluticasone (Flovent HFA, flovent Discus), Beclomethasone (Qvar).
  • Leukotriene modifiers- example : Zafirlukast (Accolate), Montelukast (Singulair)
  • Theophylline – example : Theo-24 and Elixophyllin
  • Combination inhalers – example: Advair which is a combination of Corticosteroid Fluticasone and a long acting beta agonist.

Quick Relief Medications

Quick relief medications are used at the time of asthma attack. It helps in rapid relief of asthma symptoms. They are also known as Rescue medication. Since these medicines help in preventing the symptoms from getting worse, it should always be kept with the patient.  Types of quick relief medications are:

  • Short term beta  agonist – example : albuterol, levalbuterol and pirbuterol
  • Atrovent
  • Oral or intravenous corticosteroids –  example : Prednisone and Methylprednisolone

The medications are administered with the help of a Nebuliser or using a Metered Dose Inhaler (MDI) with spacers. Nebuliser is also known as a breathing machine. It helps in delivering the medication to the child through the face mask attached to it. The child will be asked to breathe through this mask which produces a mist containing the medicine especially the bronchodilators. Nebulizer will convert medicine from liquid form to mist form. This is continued for ten to fifteen minutes and should be repeated several times a day for a good result. Metered Dose Inhalers will always have a spacer attached to it through which the medicine is delivered in aerosolized form. The spacers are used to deliver medicines directly to the lungs. Metered dose inhalers can deliver specific dose of medication. The medications most commonly used are bronchodilators and corticosteroids.

Asthma in Infants

It is very difficult to understand whether the baby suffers from asthma as the symptoms are so subtle and as the baby cannot describe the difficulties. Infant asthma should definitely be treated as untreated case leads to permanent lung damage.

The infant asthma symptoms are similar to that of adult asthma i.e., they have wheezing, coughing, shortness of breath and chest tightness. In addition to this they will be uncomfortable and will show sweating and poor feeding. Emergency care should be given to the baby if symptoms like very fast breathing, retraction, pale appearance, and cyanosis are observed.

The treatment should be started only after proper diagnosis as the symptoms such as wheezing might get confused with conditions like bronchitis, congenital heart disease, tracheoesophageal fistula, and obstruction caused by foreign body in the respiratory tract. The infant should be kept away from the triggers which may induce asthma in him. Quick relief medicines are used to control acute asthma symptoms. Bronchodilators like proventil and ventolin makes breathing easier by opening up the airways. Long term medicines are used to control the asthma symptoms. Cromolyn Sodium and Corticosteroids like prelone and pediapred are used as long term medicines in infants. The medicines are usually given in sweet liquid form or with the help of nebulisers. Medicines are also given with help of inhalers which has a spacer and mask attached to it. Spacers are small tubes which help in delivering the medicine released by the inhaler.

Asthma in Toddlers

Asthma in toddlers is very complicated as it is difficult to understand. Most of the death in toddlers with asthma occurs due to the inability of parents to diagnose the disease. As diseases like common cold and bronchitis shows symptoms similar to that of asthma it is difficult to diagnose asthma in toddlers.

The symptoms seen in toddlers during asthma attack are persistent cough which may sometimes be hacking and congested, retraction (a condition where the toddler’s skin is pulled into their chest during the intake of air), wheezing and flaring nostrils, difficulty in breathing. Due to the difficulty in breathing the child often feels difficulty in feeding. The toddler will also breathe rapidly when he suffers from asthma. The toddler will get tired very soon during the play time because of the difficulty in breathing.

The treatment mainly involves avoiding contact with the asthma triggering factors. The disease often gets cured when the toddler grows up due to increase in immunity. Medications used for treatment of toddler asthma are similar to that used in infant asthma treatment and only the dose of medicine varies. The mode of administration is also same i.e. with the help of nebulisers and metered dose inhalers.

Childhood Asthma Statistics

  • Five million children in America suffers from asthma
  • 173 children are hospitalised each year due to severe symptoms
  • Annually 863 children in America is undergoing emergency treatment
  • 14 million school days are missed due to asthma attack
  • 1.6 billion dollars are spent each year for the treatment
  • Seven percentages of all children are affected
  • National wide 5,500 deaths occur due to childhood asthma
  • The frequency of attack is higher in boys than in girls